Monitor and Manage Dental Health Care Personnel

Actively Monitor Oral Health Care Personnel.2

  • Implement sick leave policies for OHCP that are flexible, non-punitive, and consistent with public health guidance.
  • As part of routine practice, OHCP should be asked to regularly monitor themselves for fever and symptoms consistent with COVID-19 (Table 2).
    • OHCP should be reminded to stay home when they are ill and should receive no penalties when needing to stay home when ill or under quarantine.
    • If OHCP develop fever (T≥100.0˚F) or symptoms consistent with COVID-19 while at work, they should keep their cloth face covering or facemask on, inform their supervisor, and leave the workplace.
  • Screen all OHCP at the beginning of their shift for fever and symptoms consistent with COVID‑19. A useful tracking log is available from the ADA.3
    • Actively measure their temperature and document absence of symptoms consistent with COVID‑19.
    • Clinical judgement should be used to guide testing of individuals in such situations.
    • Medical evaluation may be warranted for lower temperatures (<100.0°F) or other symptoms based on assessment by occupational health personnel. For OHCP, fever is either measured temperature ≥100.0°F or subjective fever. Note that fever may be intermittent or may not be present in some individuals, such as those who are elderly, immunosuppressed, or taking certain medications (e.g., NSAIDs).
  • If OHCP experience a potential work exposure to COVID‑19, follow CDC’s Healthcare Personnel with Potential Exposure Guidance (Table 4).31
  • If OHCP suspects they have COVID-19:
    • Do not come to work.
    • If OHCP are ill at work, have them keep their cloth face covering or facemask on and leave the workplace.
    • Notify their primary healthcare provider to determine whether medical evaluation is necessary.
    • OHCP with suspected COVID‑19 should be prioritized for diagnostic testing.
    • Information about when OHCP with suspected or confirmed COVID‑19 may return to work is summarized in Table 5.32
Table 4. Guidance for Potential Occupational Exposure to SARS‑CoV‑2.31
Exposure Personal Protective Equipment Used Work Restrictions

OHCP who had prolonged1 close contact2 with a patient, visitor, or OHCP with confirmed COVID‑193

  • OHCP not wearing a respirator or facemask4
  • OHCP not wearing eye protection if the person with COVID-19 was not wearing a cloth face covering or facemask
  • OHCP not wearing all recommended PPE (i.e., gown, gloves, eye protection, respirator) while performing an aerosol-generating procedure1
  • Exclude from work for 14 days after last exposure5
  • Advise OHCP to monitor themselves for fever or symptoms consistent with COVID‑196
  • Any OHCP who develop fever or symptoms consistent with COVID‑196 should immediately contact their established point of contact (e.g., occupational health program) to arrange for medical evaluation and testing.

OHCP other than those with exposure risk described above

  • N/A
  • No work restrictions
  • Follow all recommended infection prevention and control practices, including wearing a facemask for source control while at work, monitoring themselves for fever or symptoms consistent with COVID‑196 and not reporting to work when ill, and undergoing active screening for fever or symptoms consistent with COVID‑196 at the beginning of their shift.
  • Any OHCP who develops fever or symptoms consistent with COVID‑196 should immediately self-isolate and contact their established point of contact (e.g., occupational health program) to arrange for medical evaluation and testing.
1. For individuals with confirmed COVID‑19 who developed symptoms, consider the exposure window to be 2 days before symptom onset through the time period when the individual meets criteria for discontinuation of Transmission-based Precautions
2. For individuals with confirmed COVID‑19 who never developed symptoms, determining the infectious period can be challenging. In these situations, collecting information about when the asymptomatic individual with COVID-19 may have been exposed could help inform the period when they were infectious.
  a. In general, individuals with COVID‑19 should be considered potentially infectious beginning 2 days after their exposure until they meet criteria for discontinuing Transmission-based Precautions.
  b. If the date of exposure cannot be determined, although the infectious period could be longer, it is reasonable to use a starting point of 2 days prior to the positive test through the time period when the individual meets criteria for discontinuation of Transmission-based Precautions for contact tracing.
3. While respirators confer a higher level of protection than facemasks and are recommended when caring for patients with COVID‑19, facemasks still confer some level of protection to OHCP, which was factored into this risk assessment. Cloth face coverings are not considered PPE because their efficacy to protect HCP is unknown.
4. If staffing shortages occur, it might not be possible to exclude exposed OHCP from work. For additional information and considerations refer to Strategies to Mitigating OHCP Staffing Shortages.32
5. *For the purpose of this guidance, fever is defined as subjective fever (feeling feverish) or a measured temperature of 100.0°F (37.8°C) or higher. Note that fever may be intermittent or may not be present in some people, such as those who are elderly, immunocompromised, or taking certain fever-reducing medications (e.g., nonsteroidal anti-inflammatory drugs [NSAIDS]).
Table 5. Return to Work Criteria for OHCP with Suspected or Confirmed COVID‑19.33

Symptom-based Strategy

OHCP with mild to moderate illness who are not severely immunocompromised:

  • At least 10 days have passed since symptoms first appeared and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved

Note: For OHCP who are not severely immunocompromised and who were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test.

OHCP with severe to critical illness who are severely immunocompromised:

  • At least 20 days have passed since symptoms first appeared and
  • At least 24 hours have passed since last fever without the use of fever-reducing medications and
  • Symptoms (e.g., cough, shortness of breath) have improved

Note: For OHCP who are severely immunocompromised but who were asymptomatic throughout their infection may return to work when at least 20 days have passed since the date of their first positive viral diagnostic test.

Test-based Strategy

No longer recommended, but may be considered for some OHCP, such as a severely immunocompromised provider, in consultation with an infectious disease expert if there is concern the OHCP may be infectious for more than 20 days.

Criteria for OCHCP who is symptomatic:

  • Resolution of fever without the use of fever-reducing medications and
  • Improvement in symptoms (e.g., cough, shortness of breath), and
  • Negative results of an FDA Emergency Use Authorized COVID‑19 molecular assay for detection of SARS‑CoV‑2 RNA from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens)

Criteria for OCHCP who is asymptomatic:

  • Negative results of an FDA Emergency Use Authorized COVID‑19 molecular assay for detection of SARS‑CoV‑2 RNA from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens)
  • For information on work restrictions for health care personnel with underlying health conditions who may care for COVID‑19 patients, see CDC’s FAQ.34
dentalcare.com chat Let's get started!